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CIDP IN Children

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Progressive muscle weakness after high-dose steroids in two children with CIDP.

Rostasy KM, Diepold K, Buckard J, Brockmann K, Wilken B, Hanefeld F.

Department of Pediatrics and Neuropediatrics, Georg-August-Universitat Gottingen,., Gottingen, Germany.

Steroids and intravenous immunoglobulins belong to the first line of treatment in chronic inflammatory demyelinating polyneuropathy. In patients with a progressive course, plasma exchange and immunomodulatory drugs are added to the regimen. To reduce the side effects of long-term oral prednisolone, high-dose pulse intravenous methylprednisolone treatment has been used. We report two children with chronic inflammatory demyelinating polyneuropathy who, after high-dose intravenous pule methylprednisolone, experienced a significant clinical deterioration with profound loss of muscle strength. Both patients improved after changing treatment to Immunoglobulins in one and Cyclosporine combined with Immunoglobulins and oral prednisolone in the other.
Bottom line do not use Pulse steroids in Children.


Childhood chronic inflammatory demyelinating polyneuropathy: clinical course and long-term outcome.

Ryan MM, Grattan-Smith PJ, Procopis PG, Morgan G, Ouvrier RA.

Department of Neurology, The Royal Alexandra Hospital for Children, Sydney, Australia.

We reviewed the clinical history, electrophysiologic and pathologic findings, and response to therapy of 16 children with chronic inflammatory demyelinating polyneuropathy. The majority presented with lower limb weakness. Sensory loss was uncommon. The illness was monophasic in seven children, relapsing in six, and three had a slowly progressive course. All patients were treated with immunosuppressive agents. In 11, the initial treatment was prednisolone. All had at least a short-term response but five went on to develop a relapsing course.
Intravenous immunoglobulin was the initial treatment in four patients. Three responded rapidly, with treatment being stopped after a maximum of 5 months.
In resistant CIDP in addition to prednisolone and immunoglobulin, plasma exchange, azathioprine, cyclosporine, methotrexate, cyclophosphamide and pulse methylprednisolone were tried at different times in different patients.
On serial neurophysiologic testing slowing of nerve conduction persisted for long periods after clinical recovery. Follow-up was for an average of 10 years. When last seen 14 patients were asymptomatic, two having mild residual deficits. Childhood CIDP responds to conventional treatment and generally has a favourable long-term outcome.


Childhood chronic inflammatory demyelinating polyneuropathy.

Nevo Y.

The Institute for Child Development, Division of Pediatrics, Dana Children's Hospital, Sackler School of Medicine, Tel Aviv University, Israel.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a chronic disorder of the peripheral nervous system with sensory and motor involvement, and insidious onset over a period of months. In children and adults, both proximal and distal muscles are affected. Muscle stretch reflexes are absent or depressed. Laboratory findings include elevated cerebrospinal fluid protein with no increase of mononuclear cells. Electrophysiological and pathological studies show evidence of demyelination. No control studies of the efficacy of immunomodulating therapy in childhood CIDP are available. However, several studies have indicated clinical improvement after treatment with prednisolone, plasmapheresis and intravenous immunoglobulin, but disappointing results with other immunosuppressive agents. While some children have a monophasic course, with complete recovery, others have a protracted course, with either a slowly progressive or a relapsing-remitting course, resulting in prolonged morbidity and disability.


Chronic inflammatory demyelinating polyneuropathy in childhood.

Connolly AM.

Department of Neurology, St. Louis Children's Hospital, Washington University of Medicine, St. Louis, Missouri 63110, USA.

Chronic inflammatory demyelinating polyneuropathy (CIDP) in children is relatively rare. However, it has been recognized for many years. In patients presenting with this disease, subacute onset of weakness usually develops over at least 2 months and often progresses to a loss of ambulation. Some children's initial presentations may mimic Guillain-Barre syndrome. Dysasthesias are common. Males are affected more than females, and antecedent illnesses or vaccinations occur in approximately half of patients. Physical examination reveals diffuse, proximal greater than distal weakness, with an absence or depression of muscle stretch reflexes. Electrophysiology confirms demyelination, and spinal fluid examination demonstrates albuminocytologic dissociation. The clinical presentation, diagnosis, and prognosis of childhood CIDP are reviewed. Treatment and immunologic features are also discussed in this article.
 

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Chronic inflammatory demyelinating polyneuropathy